Tag Archives: injury

09Jan/15

Bono’s arm

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Bono’s arm — Anyone who has read Bono’s recent post will know that he believes that he may not play his guitar again. As a rock and roll icon, this is a strong message that reveals the mortality of man.

Many times I have heard people tell me that they cannot do what they used to do. This is usually because of pain or a physical limitation. Often this pain and limitation has been in existence for some time before they come to see me, and hence the body has physically adapted, thinking has narrowed and avoidance assumes the default position. For this reason, the early messages about pain and injury are a vital because they set the scene for the action taken.

I do not know the full details about Bono’s arm aside from reports in the media. The injury sounded complex and nasty, requiring surgery to fix the damage. Healing always ensues, pain usually accompanies healing as do a range of other biological mechanisms such as change in movement, change in thinking and responses to different environments. Additionally we can feel unwell (the sickness response), our mood can vary, sleep is disrupted with knock-on effects, appetite may change and thinking can lose clarity. There is a very individual response to an injury, especially when it affects something very important to our self.

When helping patients to understand their pain I often tell them about the pain threshold differences in violinist’s hands — lower on the left because of the meaning of the left hand in terms of playing. If a carpenter cuts his finger, this may not be a great problem. It is certainly not unexpected. If a violinist cuts his left index finger, this could be a significant problem in terms of being able to play. Same type of injury, different meaning, therefore a different outcome: more pain, more negative thinking, more worry. This would be similar for a professional vs an amateur footballer who injures a knee ligament — the financial consequences, the loss of a place in the team etc.

The way in which Bono’s body responds to the injury will be unique to him, will reflect his health and the way he views his situation. This is the same for everyone. The uniqueness of the injury, the context, the environment and the person. For treatment and rehabilitation, this is how it must be viewed to optimise the outcomes.

Hypothetical case study

When a patient comes to see me with a complex injury, I focus on the person as much as the problem (this is one of my overarching principles). This is because it is the person who tells and lives their story, and it is the whole person I am treating, training and coaching back to a state of well-being.

Assessment would include:

  1. Exploring the narrative: gathering all the information about the injury — e.g./ the circumstances, how it happened, health status, lifestyle status, past experiences, beliefs about pain and injury
  2. Pain types: e.g. nociceptive inflammatory (possible neurogenic), neuropathic
  3. Protective measures that have been adopted: e.g./ guarding, avoidance
  4. Adaptations: e.g./ altered body sense, altered movement patterns
  5. Influences upon pain: stress, thoughts/beliefs, fatigue, emotions, other health factors, rumination

Then —

Pain understanding:

  1. This is the start point. Making sure that the person understands their pain, relevant to their condition and the action needed to overcome the pain.
  2. Getting their thinking in alignment with what we really know about pain and what it means to them to overcome pain. Achieving success is about the meaningful return to living; what is this to the patient?
  3. Cultivating the belief that their pain can be overcome and that they CAN do things with the right knowledge and ‘know how’. This is the pain coach concept.
  4. Develop the growth mindset — you may not be doing things YET; NOT YET rather than ‘I will never’. Never say never. Give it your best shot. Dedicate yourself to the fullest recovery and a return to wellbeing. Sign a contract stating this is need be, and know that you will be supported and motivated at every step.

Treatment & rehabilitation:

Depending upon the pain types (biology) and the influences upon pain, specific training is designed to achieving normal body sense, normal movement and confidence in being active and engaging in life again.

If playing the guitar is what they want to do, from word go that is how the training begins; even in plaster! Sensorimotor training begins immediately, or even before an operation. Working the sensorimotor areas is vital from a top-down perspective with specific exercises and can be started whilst immobilised with a range of imagery and visualisation techniques that work the motor centres.

When the immobilisation period ends, actual movement begins to nourish the stiffened, healing muscles and joints. After immobilisation it is normal for the area to appear different — perhaps red and swollen, a different skin quality, hair and nails can change too. Movement and sense of the area is altered and needs specific attention in the early stages because a normal perception of the body is key for healthy movement.

An early focus on function for a guitarist would include thinking and training dedicated to the fine control required to play. The actual movements are part of a sensorimotor feedforward-feedback loop that must be addressed. Adopting the right mindset is key for rehabilitation and should be practiced from the outset: a coaching model for a growth mindset.

We often do not know our full potential, so until you have given it your full dedicated attention, never say never.

08May/12

The hamstring | a common recurring problem

Football injuries, Pain Education, Sports Injuries, , , ,

The unfortunate Thiago Motta of Italy suffered what appeared to be a hamstring injury just minutes after coming onto the pitch last night. The Euro 2012 finalists were already under severe pressure from the dominant Spanish team when he was stretchered off the field clutching the back of his thigh. The Brazilian-Italian footballer was expressing his and his nation’s agony as they eventually lost 4-0.

Hamstring injuries are common in football. Often seen as the player pulling up having been sprinting, he clutches the back of his thigh, then hopping or hitting the floor. The amount of pain can vary as in any injury as pain is not an accurate indicator of the amount of actual damage.

The hamstring group is made of three muscles situated on the back of the thigh: biceps femoris on the outside, and semimembranosus and semitendinosis on the inside. They run from the pelvis to the lower leg, bending the knee but also slowing the knee down as it straightens. It is often in this latter phase that the ‘pull’ occurs.

When the muscle is pulled it can be difficult to walk. There can be bruising and swelling in the thigh, although sometimes this is deep in the leg and therefore not immediately visible. With rupture of the muscle fibres, the blood and fluid may track down the leg, causing bruising and swelling to appear lower than the injury.

With an acute injury, ‘PRICE’ is the management strategy of choice where P is protection, R is rest, I is ice, C is compression and E is elevation. In the early stages of an injury and the healing process there is pain, redness, swelling and heat. These are all manifestations of the inflammation that starts healing. Despite the unpleasantness, the signs and symptoms are the body’s responses to injury and are normal. Seeking the advice of a health professional is advisable so that you can fully understand the problem and what you must do to facilitate the most effective recovery.

When we have recovered from the acuteness of a hamstring injury, an individualised training programme must be designed, explained and implemented by a trainer or physiotherapist. This should be followed, progressed and completed to reduce the risk of future problems in the same area. The exercises and drills become increasingly functional, rehearsing the types of movements and skills needed to perform. This routine is practiced so that the player is ready physically and mentally for the demands of the game.

It is not uncommon for a twinge or similar pain to be felt in the back of the thigh sometime after the original injury. Of course there can be a re-injury where actual muscle fibres or tissue can be damaged. However, there can equally be cases whereby it feels like the original injury but there is no actual damage. In this situation, the brain has recognised the pattern of movement, determines a potential threat and responds with a pain in the back of the thigh, more as a warning shot. This means that there is still an underlying sensitivity that may have been felt as a persisting tightness (‘my hamstrings are always tight’, I often hear) or some discomfort with running or sitting with pressure on the muscles. This low level sensitivity and tightness requires a different treatment and training approach. To determine the difference, you should see a physiotherapist or other healthcare professional who can assess your situation and advise you on a specific course of action.

If you have a recurring hamtrsing injury or pain in the back of your thigh that is stopping you return to full play, call us now: T 07518 445493

29Sep/11

Mastering your rehabilitation – Part 1: why exercise & train?

Pain Education, Problematic sports injuries, Psychology, Rehabilitation, Treatments, Understanding pain, , , , , , , , , , , , , , ,

When we sustain an injury or experience a painful condition, our movement changes. In the early stages this can be obvious, for example we would limp having sprained an ankle. Sometimes the limp, medically termed an ‘antalgic gait’, persists without the individual being aware. This is the same for other forms of guarding that is part of the body’s way of protecting itself. By tightening the affected area or posturing in a manner that withdraws, the body is changing the way that we work so that healing can proceed. Clearly this is very intelligent and useful. The problem lies with persisting guarding or protection that continues to operate.

 

We know that when the brain is co-ordinating a response to a threat, a number of systems are active. This includes the nervous system, the motor system, the immune system and the endocrine system (hormones). This is all part of a defence in and around the location that is perceived to be under threat. It is important to be able to move away from danger and then to limit movement, firstly to escape from the threat (e.g. withdraw your hand from a hot plate) and then to facilitate the natural process of healing by keeping the area relatively immobilised. Interestingly, at this point our beliefs about the pain and injury will determine how we behave and what action we take. If we are concerned that there is a great deal of damage and that movement will cause further injury, we will tend to keep the area very still, looking out for anything or anyone who may harm us. Over-vigilance can lead to over-protection and potentially lengthen the recovery process. This is one reason why seeking early advice and understanding your pain and injury is important, so that you can optimise your potential for recovery.

We have established that we move differently when we are injured and in pain. In more chronic cases, the changes in movement and control of movement can be quite subtle. An experienced physiotherapist will be able to detect these and other protective measures that are being taken. These must be dealt with, because if we are not moving properly, this is a reason for the body to keep on protecting itself through feedback and feed-forward mechanisms. Re-training movement normalises the flow of information to and from the tissues to the brain. Often this process needs enhancement or enrichment as the sensory flow and position sense (proprioception) is not efficient. Movement is vital for tissue and brain health, nourishing the tissues with oxygen and chemicals that stimulate health and growth.

To train normal movement is to learn. The body is learning to move effectively and this process is the same as learning a golf shot, a tennis stroke, a language or a musical instrument. Mastery. You are asking yourself to master normal movement. What does this take? Consistency, discipline, practice (and then some more practice), time, dedication, awareness and more. The second part of this blog will look at mastery as a concept that can help you understand the way in which you can achieve success with your rehabilitation.